Locoregional treatment for hepatocellular carcinoma: The best is yet to come

Abstract

Hepatocellular carcinoma (HCC) is the sixth-most common type of cancer worldwide. The only definitive treatment modalities capable of achieving a cure are hepatic resection and hepatic transplantation. However, most patients are not candidates for these therapies. Overall, treatment options are driven by the stage of HCC. Early-stage disease is treated with ablative therapies, with radiofrequency ablation the ablative therapy of choice. Microwave ablation and irreversible electroporation are the other upcoming alternatives. Intermediate-stage disease is managed with transarterial chemoembolization (TACE), while advanced-stage disease is managed by sorafenib, with TACE and radioembolization as other alternatives.

Keywords: Hepatocellular carcinoma; High intensity focussed ultrasound; Irreversible electroporation; Microwave ablation; Radiofrequency ablation.

Figures

Figure 1

Flow chart of Barcelona Clinic Liver Cancer based management guidelines for hepatocellular carcinoma[2]. HCC: Hepatocellular carcinoma; RFA: Radiofrequency ablation; TACE: Transarterial chemoembolization.

Figure 2

Axial computed tomography images before and after radiofrequency ablation shows an arterial enhancing lesion (arrow, A). That is replaced by a hypodense area without any enhancement following radiofrequency ablation (arrow, B).

Figure 3

Irreversible electroporation for an early stage hepatocellular carcinoma in left lobe (arrow) (A and B).

Figure 4

Computed tomography 1 mo after irreversible electroporation in the same patient as Figure 4. No residual enhancement is seen (arrow).

Figure 5

Trans-arterial chemoembolisation of a large hepatocellular carcinoma in right lobe of liver (arrow, A). Following transarterial chemoembolization, there is uniform distribution of lipiodol the lesion (arrow, B).